Article 94: Staging, Western Medicine Treatment, and Traditional Chinese Medicine Remedies for Testicular Tumors
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Stage I: The tumor is confined to the testis and epididymis, and has not yet broken through the capsule or invaded the spermatic cord, with no lymph node metastasis.
Stage II: Physical examination and X-ray examination confirm that metastasis has occurred, which may spread to the spermatic cord, scrotum, and ilioinguinal lymph nodes, but has not exceeded the retroperitoneal lymphatic area.
Stage IIa refers to metastatic lymph nodes that cannot be palpated clinically, while stage IIb refers to lymph nodes that can be palpated clinically.
Stage III: There is lymph node metastasis above the diaphragm or distant metastasis. Some researchers also classify distant metastasis as Stage IV.
How does Western medicine treat this?
1. Surgical treatment: Radical orchiectomy should be performed first for all clinical stages and histological types of testicular tumors. Generally, the testis, epididymis, and spermatic cord are completely removed through an inguinal incision. If retroperitoneal lymph node metastasis is present, retroperitoneal lymph node dissection is usually performed two weeks after radical orchiectomy, or it can be performed simultaneously with the surgery. Radiotherapy or chemotherapy is then selected.
2. Radiation Therapy: Seminomas are highly sensitive to radiation therapy. For tumors confined to the testis, prophylactic radiation therapy is administered after orchiectomy, targeting the para-aortic and hip-groin lymph nodes. For tumors with retroperitoneal lymph node metastasis, in addition to the above radiation therapy, local lymph node irradiation is added, to be completed within 4 weeks, along with radiation to the mediastinum and supraclavicular region. For metastases extending beyond the mediastinum to organs such as the liver, lungs, brain, and bones, the efficacy of radiation therapy is poor.
3. Chemotherapy: Chemotherapy combined with radiotherapy can improve the efficacy of seminoma treatment. A combination of vincristine, bleomycin, and cisplatin (VBP) is commonly used. For non-seminomatous germ cell tumors, VBP treatment should be administered regularly: vincristine 0.15 mg/kg IV on days 1 and 3; bleomycin 30 mg IV on days 1, 8, and 15; and cisplatin 20 mg/m² IV on day 13. This is repeated every 3 weeks for 4 cycles. For advanced patients with abdominal masses or distant metastases, VBP combined with chemotherapy for 3-4 cycles can also be used, but the dosage needs adjustment. Vincristine 0.15 mg/kg IV on days 1 and 2; bleomycin 15 mg/m² IV once weekly; and cisplatin 100 mg/m² IV over 24 hours every 3 weeks. One course of treatment lasts 3 weeks, and 3 to 4 courses are usually used. After the tumor has shrunk in size, it is then removed.
How does Traditional Chinese Medicine differentiate syndromes and treat diseases?
In Traditional Chinese Medicine (TCM), testicular tumors are often treated using a combination of syndrome differentiation and disease differentiation, with the principles of detoxification and nodule dissipation, blood stasis removal and swelling reduction, and tonification of qi and blood. The following are some single-herb prescriptions for reference:
Traditional Chinese medicine formulas for treating testicular tumors
1. 30g of lychee seeds, 30g of akebia fruit, 3g of prepared frankincense, 30g of smilax, 3g of prepared myrrh, 3g of dragon's blood, 3g of bezoar, and 3g of prepared pangolin scales. It can be decocted in water, ground into a fine powder, or made into honey pills. Take 5g each time, 3 times a day.
2. Take 120 grams of Oldenlandia diffusa and 60 ml of honey. Decoction in water, remove residue, add honey and simmer until combined. Take orally in 6 or 8 doses over 2 days.
3. Codonopsis pilosula 15g, Sparganium stoloniferum 15g, Curcuma zedoaria 15g, Atractylodes macrocephala 12g, Poria cocos 12g, Pinellia ternata 12g, Citrus reticulata peel 12g, Citrus reticulata peel 10g, Prunella vulgaris 30g, Glycyrrhiza uralensis 3g. Decocted in water and taken orally, one dose per day. Mainly used to treat seminoma.
4. 20g of Akebia quinata, 15g of Selaginella tamariscina, 30g of Prunella vulgaris, and 30g of Lysimachia christinae. Decocted in water and taken orally, one dose per day.
5. Prepared frankincense 3g, prepared myrrh 3g, dragon's blood 3g, catechu 3g, prepared pangolin scales 3g, Zhejiang fritillary bulb 3g, bezoar 3g, clam shell powder 3g. Grind all ingredients into a fine powder. Take one dose three times a day with warm water.
6. Take 6 grams of whole scorpion, 3 centipedes, 6 grams of roasted pangolin scales, 3 grams of cinnabar, 9 grams of frankincense, and 9 grams of myrrh. Grind all ingredients into a fine powder. Take 3 grams each time, twice a day, morning and evening, with warm rice wine.